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General NPI Number Information
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NPI Number | 1689474801
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Entity Type | Individual
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Provider Name | MICHELLE DEAMICIS NP
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Gender | Female
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 4840 N MARINE DR
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City | CHICAGO
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State | IL
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Zip | 60640-7860
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Country | US
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Telephone | 773-977-4031
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 312-428-6961
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209030760
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License Number State | IL
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